Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | DC16781 | CA |
N | 111NI0900X | Internist | DC16781 | CA |
N | 111NN1001X | Nutrition | DC16781 | CA |
NPI | 1326122615 |
---|---|
Provider Name | Dr. Edward John Noa |
First Address | Fairfield, CA 94534-3470 |
Second Address | Fairfield, CA 94534-3470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T06266 | (02) | CA |